Keyholes in acetabular preparation.

None.

Quantitative assessment of the effect of 0.05% chlorhexidine on rat articular cartilage metabolism in vitro and in vivo.

Wound infection remains a problem. Syringe and needle jet lavage of chlorhexidine gluconate 0.05% removed or killed 99.8% of contaminating bacteria within 1 minute in a wound model. In clinical use, however, possible toxicity to articular cartilage is a concern. In an established intact rat patella model in vitro, 1 minute of exposure to chlorhexidine 0.05% and chlorhexidine jet lavage did not significantly alter cartilage metabolism. A 1-hour exposure decreased metabolic activity. In vivo, a 30-minute exposure with or without rinsing produced no impairment of metabolic activity 6 weeks later, suggesting that cartilage has the potential for biological recovery. However, injecting and leaving chlorhexidine 0.05% in the joints was detrimental to the metabolic activity of the articular cartilage as assessed 6 weeks later. Thus, chlorhexidine gluconate 0.05% could be used on normal articular cartilage. Any potential damage from prolonged exposure can be avoided by rinsing after 1 minute.

A comparison of 2 modern femoral cementing techniques: analysis by cement-bone interface pressure measurements, computerized image analysis, and static mechanical testing.

Modern cementing techniques aim to improve microinterlock and to reduce aseptic loosening. The Norwegian and Swedish Arthroplasty Registers have shown an increased risk of revision using reduced-viscosity cement. We have compared 2 modern cementing techniques using retrograde insertion of normal-viscosity and reduced-viscosity cements. Laboratory-simulated arthroplasty was performed in paired human femora. Performance was evaluated by measuring pressures generated during cementation, cement penetration, and shear strength of the prosthesis-cement and bone-cement interfaces. Large differences exist between these 2 modern techniques. Despite no statistical differences between the pressure measurements with the 2 techniques, greater penetration of reduced-viscosity cement was found proximally, with a trend toward increased penetration of the more viscous cement distally. Areas of greater cement penetration with reduced-viscosity cement proximally produced higher values of ultimate shear strength. Both techniques showed a progressive increase in the shear strength as the level of the section progressed toward the tip of the prosthesis. There is a trend with both techniques for the distal fixation to be stronger.

The inadequacy of standard radiographs in detecting flaws in the cement mantle.

Radiological assessment of the cement mantle is used routinely to determine the outcome of total hip replacement. We performed a simulated replacement arthroplasty on cadaver femora and took standard postoperative radiographs. The femora were then sectioned into 7 mm slices starting at the calcar, and high-resolution faxitron radiographs were taken of these sections. Analysis of the faxitron images showed that defects in the cement mantle were observed up to 100 times more frequently than on the standard films. We therefore encourage the search for a better technique in assessing the cement mantle.

The painless fracture: could it be TB?

Tuberculosis is one of the commonest infections world-wide, with one third of the world's population carrying the bacillus. Since the 1980s the decline in notification rates in the UK has stopped and recently reversed. The reasons for this are multifactorial and are discussed briefly here. We present the case of an unusual presentation of tuberculosis in the metatarsal of an elderly Caucasian gentleman. This serves as a reminder to include tuberculosis in the differential diagnoses of unusual musculoskeletal presentations.